妊娠期休克指数特点及与产后出血结局的相关性研究

目的:测定产妇在不同围产期的休克指数,研究围产期不同时期休克指数的特点,探讨休克指数与产后出血结果的关系。方法:选取2017年1月-2018年12月在恩平市人民医院妊娠足月待产的产妇共129例,根据患者产后是否发生产后大出血(即阴道分娩后24 h累计失血量>500 mL或剖宫产术后累计失血量>1000 mL),将产妇分为出血组(41例)和对照组(88例)。在两组产妇临产时、胎儿娩出后及产后12 h检测产妇的心率和收缩压,计算休克指数(休克指数=心率/收缩压),比较不同阶段两组产妇的休克指数,并分析不同阶段休克指数与产后出血量的相关性。结果:两组产妇在临产时和胎儿娩出后所测得的休克指数比较,差异无统计学意义(P>0.05)。但在产后12 h,出血组产妇的休克指数显著低于对照组,差异有统计学意义(P<0.05)。临产时及胎儿娩出后,产妇的休克指数与产后出血量无显著相关性(P>0.05)。但产后12 h,产妇休克指数与产后出血量呈显著负相关(R=-0.382,P=0.029)。结论:临产时和胎儿娩出后产妇的休克指数与产后出血无关,但产后12 h的休克指数与产妇产后出血有一定关系,可用于预测和发现产后出血。

Characteristics of shock index and its relationship with postpartum hemorrhage

Objective:To measure the shock index of puerperia at different time points during perinatal period,to explore the characteristics of shock index,and to study its relationship with postpartum hemorrhage.Methods:A total of 129 puerperia who delivered in our hospital from January 2017 to December 2018 were involved in this study.Based on whether there was postpartum hemorrhage or not(Postpartum hemorrhage was defined as the blood loss larger than 500 mL after natural labour or larger than 1000 mL after cesarean delivery),they were divided into two groups,the hemorrhage group(41 cases)and the control group(88 cases).The systolic pressure and heart rate were measured during the labor,after delivery and 12 hours after delivery.The shock index(Shock index=heart rate/systolic pressure)was calculated and compared between two groups.The relationship between shock index and bleeding volume was analyzed at different time points.Results:There was no significant difference of shock index between two groups during labor and after delivery(P>0.05).But 12 hours after delivery,the shock index in the hemorrhage group was much lower than that in the control group(P<0.05).During labor and after delivery,no significant relationship between shock index and postpartum hemorrhage was observed(P>0.05).However,there was a negative relationship between postpartum hemorrhage and the shock index 12 hours after delivery(R=-0.382,P=0.029).Conclusion:No correlation between the shock index and postpartum hemorrhage was observed during labor and after delivery.But the shock index 12 hours after delivery was related to postpartum hemorrhage,which could be applied as a potential prediction marker.